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Biomedical subjects

C M Bailey

Publications and source records attributed to C M Bailey.

At least 37 records · Page 2Linked to original sources
PubMed1999

Educational puzzles for understanding gastrointestinal physiology.

We developed four innovative, creative, and fun educational tools to promote active learning, enhance problem-solving skills, and encourage small group discussion. Furthermore, the tools encourage deductive reasoning and critical thinking rather than passive memorization of material. The tools include crossword puzzles, hidden messages, word scrambles, and word searches. These tools were developed using two computer programs: the Crossword Construction Kit and The New Puzzle Factory. Instructors are encouraged to optimize the value of the tools by using the additional options presented at the end of each of the puzzles. The additional options encourage students to become active learners by creating their own tools. Although the principles of these four tools can be adapted to many disciplines, these specific games focused on gastrointestinal physiology. Our goal was to create tools that can be used either inside or outside the classroom to complement and enhance the lecture.

Education, Medical, Undergraduate↗
PubMed1999

"Virtual rat": a tool for understanding hormonal regulation of gastrointestinal function.

This manuscript describes a "dry laboratory" using the "virtual rat" to help students understand the hormonal regulation of gastrointestinal function. The laboratory was modeled after a recent exercise that used the virtual rat to teach basic endocrine physiology. The virtual rat concept avoids the many obstacles associated with animal experimentation (for example, lack of adequate animal facilities, expense, equipment, and limited teacher experience). Our goal was to create a fun and educational experience while avoiding the complications associated with laboratory experimentation. No additional materials are required to complete this exercise. After finishing this laboratory, the students should have a greater understanding and appreciation for experimental design and the collection, analysis, and interpretation of data.

Animals↗
PubMed1999

An inquiry-based teaching tool for understanding arterial blood pressure regulation and cardiovascular function.

Educators are placing a greater emphasis on the development of cooperative laboratory experiences that supplement the traditional lecture format. The new laboratory materials should encourage active learning, problem-solving, and inquiry-based approaches. To address these goals, we developed a laboratory exercise designed to introduce students to the hemodynamic variables (heart rate, stroke volume, total peripheral resistance, and compliance) that alter arterial pressure. For this experience, students are presented with "unknown" chart recordings illustrating pulsatile arterial pressure before and in response to several interventions. Students must analyze and interpret these unknown recordings and match each recording with the appropriate intervention. These active learning procedures help students understand and apply basic science concepts in a challenging and interactive format. Furthermore, laboratory experiences may enhance the students' level of understanding and ability to synthesize and apply information. In conducting this exercise, students are introduced to the joys and excitement of inquiry-based learning through experimentation.

Blood Pressure↗
PubMed1998

Labyrinthine involvement in Langerhans' cell histiocytosis.

BACKGROUND: Langerhans' cell histiocytosis, a rare condition caused by the proliferation of abnormal Langerhans' cells ('LCH cells') and an accompanying granulomatous infiltrate, can affect several organs including the ear. External and middle ear involvement are common with a reported incidence as high as 61%. The bony labyrinth is resistant to erosion by the granulation tissue, thereby protecting the cochlea and vestibular structures. Probably for this reason, involvement of the inner ear is rare, with few case reports in the literature. PATIENTS: We report two girls, one with bilateral and the other with unilateral mastoid involvement, in whom there was invasion of the labyrinth. The first girl had 'single system' LCH affecting only bone and developed an acute hearing loss due to invasion of the cochlea, while the second had both bone and skin involvement and labyrinthine involvement was diagnosed on imaging prior to the onset of labyrinthine symptoms. CONCLUSION: Inner ear involvement can lead to permanent deafness, which may be prevented by early institution of treatment. Threatened inner ear involvement requires urgent systemic medical therapy with steroids, possibly combined with chemotherapy.

Child, Preschool↗
PubMed1998

Nurse case management to improve glycemic control in diabetic patients in a health maintenance organization. A randomized, controlled trial.

BACKGROUND: Control of hyperglycemia delays or prevents complications of diabetes, but many persons with diabetes do not achieve optimal control. OBJECTIVE: To compare diabetes control in patients receiving nurse case management and patients receiving usual care. DESIGN: Randomized, controlled trial. SETTING: Primary care clinics in a group-model health maintenance organization (HMO). PATIENTS: 17 patients with type 1 diabetes mellitus and 121 patients with type 2 diabetes mellitus. INTERVENTION: The nurse case manager followed written management algorithms under the direction of a family physician and an endocrinologist. Changes in therapy were communicated to primary care physicians. All patients received ongoing care through their primary care physicians. MEASUREMENTS: The primary outcome, hemoglobin A1c (HbA1c) value, was measured at baseline and at 12 months. Fasting blood glucose levels, medication type and dose, body weight, blood pressure, lipid levels, patient-perceived health status, episodes of severe hypoglycemia, and emergency department and hospital admissions were also assessed. RESULTS: 72% of patients completed follow-up. Patients in the nurse case management group had mean decreases of 1.7 percentage points in HbA1c values and 43 mg/dL (2.38 mmol/L) in fasting glucose levels; patients in the usual care group had decreases of 0.6 percentage points in HbA1c values and 15 mg/dL (0.83 mmol/L) in fasting glucose levels (P < 0.01). Self-reported health status improved in the nurse case management group (P = 0.02). The nurse case management intervention was not associated with statistically significant changes in medication type or dose, body weight, blood pressure, or lipids or with adverse events. CONCLUSIONS: A nurse case manager with considerable management responsibility can, in association with primary care physicians and an endocrinologist, help improve glycemic control in diabetic patients in a group-model HMO.

Algorithms↗
PubMed1998

Otologic and laryngologic manifestations of mucopolysaccharidoses after bone marrow transplantation.

INTRODUCTION: Children with mucopolysaccharidosis have significant functional impairment of a number of systems because of deposition of glycosaminoglycans. The otolaryngologic system is affected, resulting in conductive and sensorineural hearing loss and voice abnormality. METHOD: Eleven children who had undergone bone marrow transplantation had their hearing and voices assessed. Unmatched data from patients who had not undergone transplantation were collected for nonstatistical comparison. RESULTS: The hearing loss in children who had undergone bone marrow transplantation was variable but on average was less severe than in the younger children who had not undergone transplantation. The incidence of otitis media with effusion was diminished in the transplanted group. Approximately half had normal voices. DISCUSSION: Diminution of the progression of hearing loss and voice abnormality probably occurs in patients after treatment by bone marrow transplantation.

Bone Marrow Transplantation↗
PubMed1998

Management of subglottic haemangioma.

Two contrasting methods of treatment for paediatric subglottic haemangioma are presented. Dr Hoeve describes his results using intralesional steroids and short-term intubation, and Dr Froehlich discusses his outcomes with open surgical excision. Mr Bailey then reviews the currently available therapeutic options with special reference to each of the above techniques, and suggests an optimum plan of management given our current state of knowledge. The conclusion is that very small haemangiomas may not require treatment, or may be amenable to CO2 laser vaporization. Medium-sized lesions seem suitable for intra-lesional steroids and intubation, but large ones are probably best managed by primary submucous resection. Very large haemangiomas, and especially those which are circumferential or in which magnetic resonance imaging (MRI) shows extension down into the trachea and/or through the tracheal wall into the surrounding tissues, may be more safely dealt with by performing a tracheostomy and awaiting spontaneous involution.

Anti-Inflammatory Agents↗
PubMed1997

The Great Ormond Street protocol for ward decannulation of children with tracheostomy: increasing safety and decreasing cost.

Ward decannulation is the eventual endpoint for the majority of the 40 children managed by tracheostomy at Great Ormond Street Hospital each year. Our previous protocol dictated a 10 day stay in hospital for the 25 children decannulated annually. The aim of this retrospective study was to determine the minimum safe duration for this inpatient stay. In addition, we hoped to identify any factors which might distinguish potentially successful candidates from those likely to fail decannulation. Of 104 patients decannulated between January 1991 and January 1996, complete nursing and medical records were retrieved for 84 children. These notes were retrospectively reviewed and in this group of patients there were 101 attempted decannulations. Information about the initial pathology, interim course and details of the decannulation were collected. Summary statistics were generated. There was no relation between initial pathology or duration of tracheostomy and eventual success or failure of decannulation. Observations by the nursing staff of restlessness, anxiety and recession appeared more frequently in children who eventually failed decannulation. All failures occurred within 48 h of the 24 h trial of tracheostomy blocking. Our results suggest that a safe decannulation protocol can allow discharge after day five.

Adolescent↗
PubMed1997

Surgical aspects of paediatric cochlear implantation.

Cochlear implantation in the paediatric population is now an accepted method of rehabilitating profoundly or totally deaf children. The problems of cochlear implantation in children with other significant medical problems are examined. A retrospective review of the records of the first 45 children implanted at our centre was carried out. The review focused on surgical factors and outcome in addition to variations in technique which have occurred since the programme began. Congenital hearing loss was the most common indication for implantation. Fifteen children (33 per cent) had other medical problems. Three cases of flap breakdown (two occurring after direct trauma to the package bed) and one case of a misplaced electrode requiring re-implantation accounted for the only major complications to date. Minor complications included hypertrophic scar formation and post-operative wound infection. All children were using their implants at the time of this review, but two have subsequently been explanted. Cochlear implantation of children with multiple medical problems requires acceptance of a slightly higher risk of complications.

Adolescent↗
PubMed1997

Surgical experience with bone-anchored hearing aids in children.

Titanium osseointegrated implants for bone-anchored hearing aids (BAHAs) have been in use since 1977. A series of 32 children who received implantation since 1990 is reported. The report focuses on the surgical aspects of BAHAs, predisposing factors, and prevention of complications in an unusual pediatric population. The records of 32 children who had undergone two-stage implantation of a BAHA were retrospectively reviewed. The majority of the patients had craniofacial abnormalities. Of the 32 implantees, 29 use their BAHA at present. Five children failed to achieve osseointegration, and eight patients have had revision surgery for lost abutments, trauma, or chronic skin problems. There were no differences between preimplantation and postimplantation bone or air conduction thresholds. The pediatric BAHA carries with it a unique set of challenges and problems but can be successfully implanted and maintained.

Adolescent↗
PubMed1997

Measuring pediatric immunization status in a managed care organization: agreement between medical charts and parent telephone interviews.

OBJECTIVE: To measure the agreement between pediatric immunization data obtained from medical charts and data provided by parents during telephone interviews and to assess the reliability of immunization information provided during parent telephone interviews. DESIGN: Medical charts reviews and telephone interviews with parents. SETTING: Prudential HealthCare. PARTICIPANTS: Children sampled for the 1993 HEDIS study and the parents of those children (n = 356). MAIN OUTCOME MEASURE: Overall agreement between immunization data obtained from medical charts and data provided by parents during telephone interviews. RESULTS: Agreement between immunization data obtained from medical charts and data provided in parent telephone interviews varies from poor to good if the parent refers to a shot record during the interview. Agreement between the two data sources is better with single dose vaccines (i.e., 1 MMR) than multiple dose vaccines (i.e., 4 DTP). Although parents tend to report fewer immunizations than are indicated in the child's medical chart, the medical charts in this study contained too many vaccine omissions to be considered reliable "gold standards" of vaccine receipt. Parents who refer to a shot record when providing information about pediatric immunizations provide reliable data (r = .8807-1.0). CONCLUSION: When measuring completion of the immunization series, especially among parents who do not have access to a shot record, medical chart reviews remain the better approach in the managed care setting.

Child, Preschool↗
PubMed1996

Otitis media with effusion in paediatric cochlear implantees: the role of peri-implant grommet insertion.

INTRODUCTION: Otitis media with effusion (OME) is a common disease coincident with the need for cochlear implantation in 44% of the 45 children (mean = 4.8 years) currently implanted at our centre. Our suspicion that peri-implant effusion contributed to complications generated our interest in studying this issue. METHOD: Retrospective review of patient records was carried out with the focus on clinical and audiological evidence of OME before, during and after implantation. Operative records were reviewed to determine any effect OME had on the procedure and postoperative complications. RESULTS: Of our 45 implanted patients, 10 males and 10 female had OME prior to or after implantation. Pre-implant, 19 children had OME diagnosed and 11 received grommets (6 had multiple sets). Peri-implantation, 11 children had OME. These children with peri-implant effusions had 2 of 3 major, 2 of 2 intermediate and 1 of 2 minor complications. Children with peri-implant effusions also accounted for 3 of 4 cases in which there were bothersome middle ear effusions or granulation tissue at operation. The 6 children in whom grommets were placed within two months of cochlear implantation accounted for only one case of effusion at implantation and their courses were complicated only by a keloid in one child and a late flap disruption in another. SUMMARY: Insertion of grommets prior to cochlear implantation in children with peri-implant OME may provide some protection against intra-operative and some post-operative complications. Our management policy in patients with OME now aims at placing grommets such that they are in and patent at the time of implantation.

Child↗
PubMed1996

Successful complete tracheal resection in a three-month-old infant.

We report an infant with severe long-segment tracheal stenosis in whom the posterior trachea was formed by complete cartilage rings and the anterior trachea was almost totally formed by a solid cartilage plate. The child was successfully treated initially by complete resection of the trachea and primary end-to-end repair and subsequently with tracheal homograft transplantation for secondary stenosis.

Anastomosis, Surgical↗
PubMed1996

Pediatric tracheal homograft reconstruction: a novel approach to complex tracheal stenoses in children.

PURPOSE: Tracheal stenosis can be a life-threatening problem in children. Long-segment tracheal stenosis and recurrent tracheal stenosis are especially problematic. Tracheal homograft reconstruction represents a novel therapeutic modality for these patients. METHODS: Cadaveric trachea is harvested, fixed in formalin, washed in thimerosal (Methiolate), and stored in acetone. The stenosed tracheal segment is opened to widely patent segments proximally and distally. The anterior cartilage is excised and the posterior trachealis muscle or tracheal wall remains. A temporary silicone rubber intraluminal stent is placed and absorbable sutures secure the homograft. Regular postoperative bronchoscopic treatment clears granulation tissue. The stent is removed endoscopically after epithelialization over the homograft. Twenty-four children with severe tracheal stenosis (age 5 months to 18 years, mean +/- standard error of the mean = 8.18 +/- 1.21 years) underwent tracheal homograft reconstruction. All but one had had previous unsuccessful reconstructive attempts. Ten lesions were congenital, nine were posttraumatic, and five were due to prolonged intubation. RESULTS: Follow-up ranged from 5 months to 10 years (3.79 +/- 0.70 years). Twenty patients survive (20/24 = 83%), 16 without any airway problems. Four patients are still undergoing treatment. One patient requiring emergency extracorporeal membrane oxygenator support before the operation died 10 days after tracheal homograft reconstruction. Another patient with severe preoperative mediastinal sepsis died 3.5 months after tracheal homograft reconstruction. Two patients with functional airways died late of unrelated problems. CONCLUSIONS: Tracheal homograft reconstruction demonstrates encouraging short-term to medium-term results for children with severe recurrent tracheal stenosis. Postoperative bronchoscopic and histologic studies provide evidence of epithelialization and support the expectation of good long-term results.

Adolescent↗
PubMed1996

Tracheal reconstruction in children using cadaveric homograft trachea.

OBJECTIVE: We report the use of cadaveric human tracheal homograft in the treatment of severe long segment congenital tracheal stenosis in children. METHODS: Five children (aged 5 months-8 years) with severe life-threatening airway obstruction due to long segment congenital tracheal stenosis had failed conventional management. All were ventilator dependent or rapidly deteriorating at the time of surgery, two were on extracorporeal membrane oxygenation, and no alternative therapy was available. The stenosed trachea was removed and the posterior trachealis muscle left in situ when possible. Surgical technique involved the use of cardiopulmonary bypass in four of five cases. Stored cadaveric tracheal homograft tissue was shaped and inserted over a silastic intra-luminal stent which was kept in place for up to 3 months. Regular bronchoscopy was necessary postoperatively to clear granulation tissue, which resolved on removal of the stent. RESULTS: Four patients are all now without stents, intubation or tracheostomy. Three are without airway problems 16, 14, and 9 months after surgery and one attends for occasional dilatation of a distal tracheal stenosis, but is now at home despite other severe multiple congenital problems. One patient presented with complete disruption of the trachea and mediastinal sepsis and was supported on extracorporeal membrane oxygenation prior to surgery; this patient eventually died of airway failure and sepsis. CONCLUSIONS: The application of cadaveric human tracheal homograft to congenital tracheal stenosis is novel. Its use in five children who would otherwise have died has provided an extra therapy in an extremely difficult group of patients.

Airway Obstruction↗
PubMed1996

Nasal lipomas presenting as part of a syndromic diagnosis.

An important part of the initial assessment of children presenting with congenital nasal masses is to exclude an intracranial extension using either magnetic resonance imaging (MRI) or computed tomography (CT) imaging. We present three patients with such lesions in which unusual radiological findings were noted as part of the investigations.

Female↗
PubMed1996

Craniometaphyseal and craniodiaphyseal dysplasia, head and neck manifestations and management.

Craniometaphyseal and craniodiaphyseal dysplasia are rare genetic disorders of bone due to modelling errors of long bones and skull bones. These syndromes present with multiple ENT symptomatology from an early age. The diagnostic distinction can now be made radiologically by serial skeletal survey which is important for prognosis. We review the clinical, radiological, computed tomography (CT) scan, otological, audiological and histopathological findings in two cases with craniodiaphyseal, and two cases with craniometaphyseal dysplasia, and report our experiences of medical and surgical treatment to date. In the craniodiaphyseal dysplasia, the hearing abnormality progressed from an initial conductive to a mixed loss on serial audiometric follow up. Temporal bone CT scans showed narrowing of the middle ear cavity, internal auditory meatus, and facial nerve canal at the geniculate ganglion. Benefits from choanal stenosis surgery, craniofacial remodelling and dacrocystorhinostomy were shortlived. Calcitriol therapy with a low calcium diet did not alter the clinical course of progression in our cases. The underlying defect, causing net bone formation in these phenotypically similar syndromes, appears to be different when based on the differing biochemical responses to calcitriol and bone biopsy findings. Increased numbers of osteoblasts were found in bone biopsies from both cases with craniodiaphyseal dysplasia. Early recognition is crucial in these conditions as therapy directed at the underlying bony defect has the best chance of success if initiated in infancy.

Adult↗